Avenue Hospital Nairobi
Industrial Area Clinic
City Centre Clinic
Ngong' Road Clinic
Garden City Clinic
Green Span Clinic
South C Clinic
Avenue Hospital Kisumu
Ongata Rongai Clinic
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Avenue Rescue Services
What is Managed Health Care?
A health delivery and financing system where an enrolled population pays a fixed annual fee (capitation) to a medical provider for access to health services as needed.
Financing Health Care The Managed Care Model
There are many models for finance and delivery of medical services, among which are self- financing (out of pocket as need arises) and various forms of risk pooling. The high cost of medical care, particularly in case of hospitalisation, makes self financing out of reach for all but the wealthiest members of society.
Thus risk pooling - where a large number of people contribute a small amount each year, or the benefit of the relatively few who actually become ill - has gained a significantly greater role.
The Challenge of Affordable, Accessible Care
In a developing country, with limited resources, the challenge is to ensure that resources available are put to their most efficient use, and it is therefore important to encourage providers to offer creative alternatives to government health care provision.
Avenue Healthcare offers affordable high quality medical services in the market based on the principals of Provider-based Managed Healthcare. This form of risk pooling eliminates the need for costly middle men, such as insurance companies, by making the medical provider itself a repository for the pooled funds.
The provider, instead of investing in office buildings, the stock market, or interest bearing bonds, uses member funds to build hospitals, clinics, and otherwise invest in medical equipment and facilities to be used for patients as need arises. This direct link from patient to provider offers the most efficient solution in reducing costs while providing a regular and predictable source of income for the provider.
Financial Risks of Medical Care Fee for Service
-Risks associated with the costs of medical care are borne by the patient.
-Insurance Risks associated with the costs of medical care are borne by a third party.
-Capitation Risks associated with the costs of care are transferred to the provider.
- Different health finance mechanisms have different systems of incentives.
- Incentives are influenced by costs.
- The party undertaking to pay is the one who has the incentive to reduce costs.
Incentives in Fee for Service
- Patients have incentives to control costs but cannot determine treatment.
- Only the provider is able to control costs, but providers have little incentive to do so.
- Provider incentives to give more medical care contribute to escalating costs.
Incentives in Managed Care
- Because services are prepaid, providers have incentives to reduce costs.
- Providers have incentives to keep members healthy, not just treat illness.
- Prevention is better and cheaper than cure.
- In a competitive environment, providers have incentives to give high quality, effective care.
Objectives in Managed Care
- Provide high quality medical care.
- Provide care efficiently.
- Reduce costs to patients.
What Managed Care Does?
- Integrates Services.
- Coordinates Care.
- Maintains Health.
• Brings all aspects of health care under one umbrella, giving patients easy access to the care they need.
• Manages and directs caregivers to ensure comprehensive, efficient and effective treatments.
• Has a vested interest in ensuring its members remain as healthy as possible.
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